Provider Demographics
NPI:1649570250
Name:WOLFSON, SARA LYNNE (APRN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LYNNE
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 S 110TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3115
Mailing Address - Country:US
Mailing Address - Phone:402-201-1977
Mailing Address - Fax:
Practice Address - Street 1:2104 S 110TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3115
Practice Address - Country:US
Practice Address - Phone:402-201-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAJ-126582363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology